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Study Design   Retrospective studyObjectives   Due to anatomical variations in the semispinalis cervicis insertion in the C2 spinous process, complete preservation is not always possible when the C3 level is included in a cervical laminoplasty. Three-dimensional computed tomography was used to evaluate the relationship between the incidence of semispinalis cervicis injury and the C2 inter-spinous angle.Methods   We included 95 patients who underwent a cervical laminoplasty that included a C3 laminectomy for cervical myelopathy. Patients with a C2 inter-spinous angle above and below 60° were classified into wide- and narrow-angled groups, respectively (n = 48 and n = 47). Whether the C2 semispinalis cervicis insertion was preserved, or detached and reattached was reviewed from surgical records. The pre and postoperative C2-C7 lordosis and range of motion (ROM) were measured, and clinical outcomes were obtained from the patient charts.Results   The C2 semispinalis cervicis was preserved in 47 patients (97.9%) in the wide-angled group but only in 14 patients (29.8%) in the narrow-angled group ( P &lt; .001). The postoperative C2-C7 lordosis extension and ROM were significantly greater in the wide-angled ( P = .048 and .036). Postoperative neck pain was significantly greater in the narrow-angled ( P = .018).Conclusions   The morphology of the C2 spinous process indicates that a C2 semispinalis cervicis insertion preservation is possible during a cervical laminoplasty that includes a C3 laminectomy. A careful surgical procedure should be conducted when the C2 inter-spinous angle is above 60° to increase the likelihood of achieving this preservation and thereby obtaining a more favorable clinical outcomes.

Relationship Between C2 Semispinalis Cervicis Preservation and C2 Spinous Process Morphology During Cervical Laminoplasty Involving C3